“We deplore victims throughout the country”

“Courtney discovered the pills in high school. It turned into addiction and led to her death from a fentanyl overdose. She was 20.” During his State of the Union address to Congress on Tuesday, February 7, Joe Biden took the time to “to share a story well known to millions of Americans”. That of the opioid crisis, which has hit the United States for more than 30 years.

These opium derivatives include both legal analgesics, such as morphine or oxycodone, prescribed for pain, and illicit substances such as heroin. According to the US Centers for Disease Prevention and Control (CDC)*, more than 564,000 Americans died from an overdose of one of these products between 1999 and 2020. And the crisis has accelerated: opioids have cost the lives of nearly 82,000 people between February 2021 and February 2022, lists the federal agency in one of its latest reports *.

The extent of opioid addiction across the Atlantic remains difficult to assess. A distinction must be made between painkillers taken as part of a medical treatment, and those which are “diverted from their original use” or purchased on the black market. But “drugs such as oxycodone, in high doses, can also make individuals enter into addiction”warns Elisa Chelle, professor of political science at the University of Paris Nanterre and author of Understanding health policy in the United States (EHESP Press, 2019).

“No place in the United States is spared”

A simple prescription for a wisdom tooth operation can therefore sometimes lead to self-medication, or even to the purchase of illegal substances. This phenomenon has been further accentuated with the emergence of fentanyl. Developed to meet a need for more effective painkillers, this synthetic opioid is 80 times more potent than morphine, according to the National Institute of Drug Addiction (Nida)*.

In its authorized form, it is used in the treatment of serious pain, for example for terminal cancers. But since 2019, illegally manufactured pills (and often in far too high a dosage) have become a cheap, plentiful, and extremely addictive street drug.

Fentanyl alone is responsible for the death of “more than 70,000 Americans each year”, recalled Joe Biden on Tuesday during his speech *. It is now the main cause of death among 18-49 year olds, according to a river survey of the Washington Post* published in December. While overdoses mostly affected white and rural populations in the East, fentanyl-related deaths exploded over the past three years among blacks and Hispanics, reports Bloomberg*.

Already in 2019, “Special Envoy” was interested in the devastation caused by this analgesic. “No place in the United States is spared. We deplore victims in all counties”confirms Wilson Compton, doctor and deputy director of Nida, a federal research agency on drugs and addiction.

“Since the 1980s, the number of opioid overdoses has increased exponentially. This epidemic is spreading like an infectious disease.”

Wilson Compton, Deputy Director of Nida

at franceinfo

The Covid-19 pandemic has been there. “I he mental health of many Americans has been compromised, making some more vulnerable to risk addiction”, points out Elisa Chelle. During the health crisis, the number of evictions and homeless people also increased sharply in the United States. “ The risk of a fatal overdose is higher when you live on the streets or live alone.”two more frequent situations during this period, recalls Chelsea Shover, epidemiologist and professor at the school of medicine at UCLA University (California).

Counterfeit pills that kill in an instant

Some die without even knowing they took fentanyl, often used to cut illegal drugs. It therefore claims victims not only among people suffering from an addiction to this type of substance, but also among users of cocaine, cannabis or methamphetamines, reports Bloomberg.

It is also used in the manufacture of counterfeit drugs sold on the black market, such as adderall and ritalin, used for attention deficit hyperactivity disorder (ADHD). Gold, “a trace amount of fentanyl can cause respiratory distress and death”, notes Wilson Compton. “It’s so potent that teenagers, especially those who have never used opioids before, can die…in seconds to minutes”a Boston hospital specialist told CNN*.

Young consumers are mainly supplied on social networks, in particular on Snapchat, noted the American channel CNBC* at the end of January. This is the case of Zach, 17, who died in 2020 after buying what he believed to be percocet, a prescription painkiller. The pills he was sold were actually cut with fentanyl, as established by investigators quoted by CNN.

Mexican cartels on the move

These stamps probably came from Mexico. No fewer than 379 million doses of fentanyl were seized in 2022, mainly at the border with the neighboring country, the US federal drug control agency announced at the end of December. The DEA has made it clear that its priority is to “defeat the two main cartels [mexicains] Sinaloa and Jalisco”which supplanted China, responsible for the first shipments of illicit fentanyl, bought on the black market online and sent by post.

Because this substance is inexpensive and relatively easy to produce, unlike heroin or cocaine. “There is no need for peasants to cultivate coca or poppy fields. To make fentanyl, you just have to mix chemicals [achetés en Chine] in clandestine laboratories”notes Romain Le Cour Grandmaison, doctor of political science at the University of Paris-1 Panthéon-Sorbonne and senior expert at Global Initiative.

Mexican cartels are now flooding the United States with these stamps, and cTrafficking has been at the heart of the debate between Democrats and Republicans. “In 2016, Donald Trump notably campaigned for the presidency on this issue” , recalls Romain Huret, historian specializing in the United States and president of the Ehess. The curator then promised a wall to stop illegal migrants who, according to him, were carrying the bulk of illegal opioids. But the reality is quite different reveals the DEA in a report published in March 2021 (in PDF)*.

“The majority of fentanyl enters the United States through legal checkpoints, in vehicles driven by American citizens. So this crisis is not just about border security.”

Chelsea Shover, epidemiologist

at franceinfo

Especially since fentanyl remains difficult to detect. “These are little pills, easier to hide than packs of cocaineexplains Romain Le Cour Grandmaison. Countering this traffic is looking for a needle in a haystack” . To avoid the resurgence of overdoses, “therefore, above all, public health measures are needed”believes the political scientist.

Towards better dependency care?

This is precisely one of the two axes of the action plan announced in the spring of 2022 by Joe Biden. “It’s time we treated addiction like any other disease”, estimated the American president *. For this, the Federal State has released 1.5 billion dollars, in particular with a view to better management of opioid addiction. “Many Americans do not have access to centers offering appropriate treatment, especially in rural areas, nor the means to pay for this care”says Chelsea Shover.

Part of this envelope must also be used to reduce the risk of overdoses, for example “distributing tests to ensure that fentanyl [acheté au marché noir] is not dangerous” because overdosed or mixed with other products, details Wilson Compton, deputy director of Nida. “We’re also working to make naloxone, a drug that reverses the effects of an opioid overdose, more available. It’s a safe and easy way to save lives.”

However, the application of these measures varies enormously from one American state to another. “Health is not a federal jurisdiction, so the Biden administration has limited wiggle room”, points out Elisa Chelle. Some Democratic states, such as New York* or California*, have invested heavily in these public health issues. But in conservative territories, addiction is seen as a “moral weakness”. “There is strong opposition from Republican officials and voters to these measures”continues the political scientist.

“The opioid crisis is multifactorial. So there is no single solution to stop the mechanics.”

Elisa Chelle, political scientist

at franceinfo

It is also necessary to develop “housing and employment policies that respond to social despair” of some Americans. “Treating the consequences of addiction is essential”but to tackle the root of the problem, by “preventing people from falling into addiction”is just as much, she insists.

* These links refer to content in English.